The Dry Eye Zone

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Abstract: Surgical approaches to dry eye

The abstract of course doesn't include what we really want to see (the flowchart) but amongst what it does tell us is the important message that surgical approaches should not be attempted unless there are clinical signs present.

Flow chart on surgical approaches to dry eye.
Geerling G, Brewitt H.
Dev Ophthalmol. 2008;41:313-6.

Introduction: Based on the type and severity of dry eye, we propose a structured approach to the surgical management of the disease.

Material and Methods: The guidelines for assessing the form and grade of dry eye as recently suggested by the 'Dry Eye Workshop (DEWS)'. Flow chart on the surgical and medical management are presented.

Results and Conclusion: Surgery should only be considered if any significant inflammation and concomitant adnexal disease has been controlled and medical management remains insufficient to control signs and symptoms of dry eye. The presence of signs of surface disease is considered mandatory. Although infrequent pre-existing occlusion of the lacrimal drainage system should be excluded, since this can also induce surface disease. The suggested sequence of treatment options makes use of less invasive procedures first while at the same time maximising efficacy and practicality. Often several measures have to be applied simultaneously to prevent loss of vision. Visual rehabilitation should only be attempted (e.g. by means of stem cell transplantation, keratoplasty). Once all concomittant factors have been addressed and measures to substitute the tear have been applied. In persisting aqueous deficiency osteoodontokeratoprosthesis remains the final option to improve visual function.
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